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A D V E R T I S E M E N T
A D V E R T I S E M E N T
If definitive information on the site of a stroke is needed and/or if thrombolytic therapy is instituted, cerebral angiography is employed, in this case, showing occlusion of the right middle cerebral artery.
A D V E R T I S E M E N T
If a stroke patient is seen within three hours of the onset of the event, thrombolytic therapy can be administered. This can take the form of intravenous systemic infusion of tissue plasminogen activator (TPA) or focal catheter infusion of urokinase. The former is simpler and quicker, can be administered in the emergency room, but carries the risk of systemic coagulation problems. The latter requires immediate interventional radiology. After three hours, the risk of reperfusion injury from free radicals contraindicates the use of thrombolytic therapy. General stroke management is conservative, i.e. reasonable blood pressure control, monitoring, and treatment of increased intracranial pressure.
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A D V E R T I S E M E N T
Atherosclerotic changes are most pronounced in areas where turbulence damages the endothelium, such as branch points. The carotid bifurcation is a common site of atherosclerotic plaque. The plaque leads to cerebrovascular injury in two ways. Critical narrowing can limit flow and may progress to total occlusion. Even before mechanical occlusion, the slowed flow can lead to distal thrombosis. The second mechanism of injury is due to the unstable nature of the plaque surface and the tendency to ulcerate and throw off atherosclerotic and platelet emboli. The turbulence caused by narrowing often causes a sound audible by stethoscope (bruit).
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This page was last modified on 7/20/1999.
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